Care Coordination Manager

• Community Health Services: WIC, Commodity Supplemental Food, Foster Grandparents, Migrant Seasonal Head Start, and Child Development Center.
• Clinical Health Services: Primary Care, Reproductive Health, Diabetes Management, Immunizations, Migrant Health, Ryan White HIV; Behavioral Health including Counseling Services, Medication Management, Medication Assisted Treatment and Substance Use Counseling and Intensive Outpatient Services and Dental Services.
• Supportive Health Services: Family Stabilization, a Teen Outreach Program, SOAR, Youth Leadership Program, Youth Shelter, and Housing Assistance Programs.

OUR PROMISE: Community Action changes people’s lives, embodies the spirit of hope, improves communities, and makes America a better place to live. We care about the entire community, and we are dedicated to helping people help themselves and each other.

VISION

Communities where everyone has an opportunity for a successful life.

MISSION

The Mission Statement of the Community Action Partnership of Western Nebraska is to provide quality services and promote learning opportunities to improve nurture the health and well-being of Western Nebraska communities.

KEY BELIEFS

• Integrity—We treat all people with dignity and respect.
• Compassion—We believe working compassionately with people enriches all.
• Inclusion—We are inclusive and advocate for diversity.
• Collaboration—We believe working in partnerships strengthens communities; we seek mutually beneficial partnerships that advance a common mission.
• Innovation—We embrace opportunities to learn, grow and make wise choices.

COMPETITIVE BENEFITS PACKAGE:

● Health ● Dental ● Vision ● Health Savings Account (HSA) ● Flex Plan ● 401k ● Basic and Voluntary Life Insurance ● Ten Paid Holidays ● PTO ● Extended Illness (EIB) ● Employee Assistance Program ● Aflac ● Community Discounts ● Potential for Incentive Pay ●

Care Coordination Manager

Full-time

Job Title: Care Coordination Manager

Reports To: Chief Strategy Officer

Areas of Responsibility: Manage Migrant Health, Ryan White Part C, and Community Health Worker programs (Assigned Programs) for patients and provide care management for all patients. Provide leadership to Community Health Workers (CHWs) through training, mentoring, and case conferencing. Demonstrates an advanced level of communication and interdisciplinary collaboration, professionalism, and systems-based thinking with an emphasis on the importance of patient-centered care, education, and organizational involvement to meet the team’s identified goals.

Major Duties:

1. Demonstrates an advanced level of communication and interdisciplinary collaboration, professionalism, and systems-based thinking with an emphasis on the importance of patient-centered care, education, and organizational involvement to meet the team’s identified goals.
2. Responsible for planning all aspects ofthe Assigned Programs in accordance with the Federal rules and regulations for the Bureau of Primary Health Care and in coordination with other Assigned Programs rules and regulations.
3. Supervise staff and facilitates onboarding, orientation, and training to promote growth of team members in areas of patient-centered care, education, and cross organizational care. Effectively communicate feedback and provide ongoing coaching and mentoring to staff while supporting a learning environment to advance team skills and promote professional development.
4. Provides leadership, training, and mentoring to Community Health Workers in case management through case conferencing and meeting the goal of supporting patients with their social and health needs to navigate and access community resources, social services, and medical systems.
5. Act as a subject matter expert on CHW program workflow and care model, providing leadership, guidance, and best practice techniques to staff.
6. Assign incoming patient referrals and monitor volume of referrals assigned to staff.
7. Coordinate health and educational services for Assigned Program patients.
8. Be a spokesperson and advocate for patients when they are unable to speak for themselves, functioning as liaison with health care providers, institutions, pharmacies, and community organizations associated with the Assigned Programs.
9. Oversee the voucher system; pre-authorize appropriate client services meeting state, federal, and CAPWN program guidelines and manage and maintain a voucher tracking system.
10. Serve as a lead community representative by attending community coalition and workgroup meetings, making presentations on behalf of the programs and fostering collaborative relationships with community partners, community resources, health plans, and providers.
11. Development and oversight of program operations including development of relevant policies, work closely with Program Director on day-to-day program operations and ensure staff have the needed tools and resources to achieve goals and ensure compliance.
12. Assure that clients receive culturally competent health and educational services by providing continual coaching support and guidance in promoting adherence to the CHW Care Model and other evidence-based practice.
13. Assist in the preparation of the Community Health Center Grant application to the Bureau of Primary Health Care by submitting narrative and statistical reports necessary for the Assigned Program portions of the application.
14. Prepare and monitor Assigned Programs budgets.
15. Provide monthly reports as appropriate and as requested.
16. Participate in the Quality Assurance/Quality Improvement Committee including requirements for Ryan White Part C.

1. Set up and facilitate Quality Initiative Team (QIT) meeting.
2. Gather data and prepare clinical measures spreadsheet.
3. Point person for quality improvement initiatives.
4. Prepare minutes from QIT meetings.
5. Review and revise Clinical Quality Management Plan

1. Ryan White and Nebraska Aides Project facilitation:

1. Point person for setting up annual monitoring visit with CAPWN and Nebraska Aides Project. Make sure monitoring visit to contractor’s mimic questions from federal site visit process.
2. Liaison with contracting providers if there are issues with contract.
3. Liaison with Ryan White HIV/Aides Program project officer.
4. Liaison with state Ryan White Part B Program and Nebraska Medicine Ryan White Part C Program.
5. Participate in Nebraska Medicine Specialty Care Clinic (SCC) meetings.
6. Representative on NE HIV Cares meetings.
7. Representative for Nebraska Ryan White meetings.
8. Organize and facilitate Ryan White Administrative meetings; minimum 2 times per year.

1. As a CAPWN team member, dedicate your energy to providing high quality, value-added customer service and care to our clients. Embrace the CAPWN Standards of Behavior, practicing integrity, strong communication and respect for leaders and peers. Engage with the team and commit to improving and nurturing the health and well-being of the Western Nebraska Communities we serve.
2. Other duties as assigned.

Working Conditions:

• Office setting including training, meetings.
• Travel and work with partners within the community and panhandle.
• Work receives limited supervision and requires the ability to take initiative and be self-directed.

Physical Requirements:

• Ability to bend, stoop, squat, crouch, push and pull file drawers.
• Fine manipulation of hands for repetitive action.
• Occasionally lift and carry up to twenty-five pounds.
• Physically and emotionally able to collaborate with other staff and families.

Minimum Qualifications:

Grade 15

• High School diploma or GED
• Two (2) years’ experience in working with migrant and seasonal farm workers.
• Requires proficient level of oral and written communication skills in English and Spanish.
• Proficient computer skills with Microsoft programs.
• Age 21+
• Valid driver’s license with good driving record and insured vehicle available.
• Strong interpersonal and initiative skills.
• Physically and mentally able to perform duties.

Grade 16

• Meet the minimum qualifications above AND
• AA degree in Social Work or related field OR four (4) years management experience.

Grade 17

• Meet the minimum qualifications above AND
• Additional specialized training or certifications applicable to the position.